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Background In view of circulatory diseases, most previous studies focused on the impacts of air pollution and meteorological factors, while ignoring the influence of built environment. Objective To investigate and quantify the impact of built environment on circulatory diseases in China. Methods Circulatory disease mortality data and built environment data (including urban greenery coverage, urban land use, urban land use mix, urban road facilities and urban medical facilities) of 17 cities in China from 2000 to 2019 were collected. Multiple linear regression was used to analyze which built environment elements had significant influence on circulatory diseases, and to quantify their effects. Furthermore, the changes of built environment indicators on circulatory disease mortality were evaluated under different levels of urban economic development and various air quality. Results The built environment affected the mortality of circulatory diseases during the study period (P<0.05). Urban green space and commercial land area were negatively correlated with circulatory disease mortality, and regression coefficients were −0.550 and −0.280, respectively (P<0.05). On the contrary, the increase of urban road area, residential land ratio, and the degree of land use mix were positively associated with circulatory disease mortality, and their regression coefficients were 0.322, 0.283, and 0.176, respectively (P<0.05). When the level of urban economic development was low, the impact of commercial land use ratio on circulatory diseases was stronger, and the regression coefficient was −0.476 (P<0.05). When urban air pollution worsened, the impacts of per capita green coverage area and per capita urban road area on the disease were more prominent, and the regression coefficients were −0.528 and 0.372, respectively (P<0.05). Conclusion There is a significant correlation between urban built environment and mortality of circulatory diseases. To be specific, circulatory disease mortality has a negative correlation with per capita green coverage area and commercial land use ratio, and a positive correlation with per capita urban road area, residential land ratio and degree of land use mix.
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Objective:To explore the treatment efficacy of neuroendoscope-assisted exploration and release of the outflow tract of the fourth ventricle in patients with Chiari malformation type I.Methods:Ninety-five patients with Chiari malformation type I, admitted to our hospital from January 2016 to January 2020, were chosen in our study. Patients from observation group ( n=57) were treated with posterior cranial fossa decompression+subdural tonsillectomy+endoscope-assisted exploration and release of the outflow tract of the fourth ventricle+enlarged reconstruction of the occipital cistern. Patients from control group ( n=38) were treated with posterior fossa decompression+subdural tonsillectomy+enlarged reconstruction of the occipital cistern. All patients were followed up for one year. Data of surgical duration, intraoperative blood loss, postoperative length of hospital stay, and incidence of complications were retrospectively analyzed in patients from the two groups, and the imaging changes of spinal cavity were observed before surgery and during postoperative follow-up. Chicago Chiari Outcome Scale (CCOS) was used to evaluate the prognoses of all patients (scores of 11-16 were defined as good prognosis). The differences of good prognosis rate among patients with different gender, age, degrees of tonsillar herniation and distributions of spinal cavity segments were analyzed. Results:There was no significant difference in surgical duration, intraoperative blood loss, postoperative length of hospital stay or incidence of complications between the two groups ( P>0.05). As compared with the control group (65.5%), the observation group had higher syringomyelia minification (75.5%) during postoperative follow-up, without significant difference ( P>0.05). The good prognosis rate of the observation group during postoperative follow-up (91.2%) was significantly higher than that of the control group (78.9%, P<0.05). Female patients, patients with age≤45 years, and patients with tonsillar herniation level below the atlas had significantly higher good prognosis rate than male patients, patients with age>45 years, and patients with tonsillar herniation level between the foramen magnum and the atlas during postoperative follow-up, respectively ( P<0.05). Conclusion:As compared with conventional surgery, neuroendoscope-assisted exploration and release of the outflow tract of the fourth ventricle is more effective in patients with Chiari malformation type I, and the good prognosis rate is likely higher in female patients, patients with age≤45 years, and patients with tonsillar herniation level below the atlas.